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Population, health and Union Budget: Lack of demographic, epidemiological intelligence

By IMPRI Team

The Centre for Human Dignity and Development (CHDD), Impact and Policy Research Institute (IMPRI), New Delhi, hosted an interactive panel discussion on the topic “Population, Health, and Union Budget 2023-24”, on February 3, 2023, under the IMPRI 3rd Annual Series of Thematic Deliberations and Analysis of Union Budget 2023-24, as part of IMPRI #WebPolicyTalk. The discussion was chaired and moderated by Dr. Devendra Singh, a professor at the University of Freiburg, Germany, and a Visiting Senior Fellow at Impact and Policy Research (IMPRI).
The session was inaugurated by Ms Nayna Agarwal, a researcher at IMPRI, who welcomed and gave a brief introduction to the chair and panelists of the discussion. The Panelists for the discussion were Prof Sanghmitra Sheel Acharya, Professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University (JNU), New Delhi; Prof Pradeep K. Panda, Professor and Dean, School of Public Health, Asian Institute of Public Health (AIPH) University, Bhubaneswar; Prof Praveen Jha, Professor, Centre for Economic Studies and Planning, School of Social Sciences, Jawaharlal Nehru University (JNU), New Delhi and Mr Abhijit Mukhopadhyay, Senior Fellow, ORF.
Prof. Singh began the discussion with a warm greeting, and then laid the agenda for the discussion. The budget is no more a simple statement of revenue, expenditure, and allocations for the coming year; but a window of the thinking of the government. He called the budget a vision document of national priorities. He also highlighted the centrality of health, for the individual, society, and the country; the looming issue of population age structure shift. He thus emphasized the need for demographic and epidemiological intelligence to be the guiding force for the population health budget.
His initial impression of the budget was marked by the lack of demographic intelligence, with a lack of focus on the changing age demographic. This was seen in the form of no special pivot provided to the young population as well as the gap in additional schemes or allocations for the older population. We are also lagging behind the spending envisaged by the incumbent government i.e.2.5% of the GDP by 2025 in its National Health Policy 2017.
Prof. Singh laid out the focus area of the panel discussion for the panelists: an overall impression, the emergent priorities in the field of population and health, and what they would have liked to see in the budget.
The discussion was taken forward by Prof. Praveen Jha who began the discussion by comparing last year’s expenditure (approximately 42 lakh crores) with this year’s (approximately 45 lakh crores) which owing to factors like inflation in the real term aggregate expenditure is going down. He cited the drop in the expenditure in nominal terms in both National Health Mission and National Education Mission, the real would be even sharper. The government has certain schemes titled ‘core schemes’, these are areas of focus while formulating policies and locating resources, however, out of the six core schemes five have witnessed a cut in allocation.
He mentioned Dr. Amartya Sen’s words, about India possibly being the only country, which hopes to become a superpower by neglecting health and education. While mentioning Prof. Singh’s words on demographic dividends, highlighted the possibility of having not used it in any substantive fashion; also pointed out the possibility that India has turned into a demographic disaster – the issue of educated unemployment. Focus on infrastructure, and the expenditures there can only take you so far. The need is to be focusing on the structure of growth, the structure of the capital infrastructure, and going to extremely important sectors and segments, the MSME, for instance. According to Prof. Jha, this will give us a true dividend–the one Prof. Singh was alluding to.
The next panelist, Prof. Pradeep K. Panda started the discussion by highlighting the central government’s commitment to fiscal consolidation, which requires deficit reduction. He welcomed the decision to reduce revenue expenditure and reallocate the amount for capital expenditure to support and boost growth. We saw a rise in allocation for the health sector both in revenue and capital, by 12.6% in the financial year 2024 over 2023, however, it’s share in the GDP remained quite low at 0.3% in both financial years 2023 & 2024.
Prof. Panda noted and appreciated the decision to start the 157 new colleges, a mission to eliminate sickle cell anemia by 2047, and collaboration between ICMR & Public and Private medical facilities for using the ICMR laboratory for research and innovation killing manpower for manufacturing of medical technology. He also mentioned the 12% increase witnessed (in nominal terms) by the Pradhan Mantri Jan Arogya Yojana.
Prof. Panda spoke about missing middles, people who do not have any health insurance, thus, paying for their health expenses from their pocket; the budget not doing enough to include this section of the population. The lack of any major move toward strengthening the health infrastructure, especially the primary healthcare sector. To achieve Universal Health Coverage, public health needs to be ramped up, he reiterated the need to devote at least 2.5% of GDP exclusively to health. Citing Delhi as an example, Prof Panda brought to light the issue of non-communicable disease (NCD) and the non-allocation of funds for this particular menace. The Tertiary Healthcare Programme of the center covering all major NCDs saw a reduction to 289 crores from 500 crores last year.
The discussion was taken ahead by Prof Sanghmitra Sheel Acharya by mentioning the proportional fall from 2.2% to 1.97% of the allocation for healthcare; this is the backdrop of all that we have been promised. She spoke about digitalization and the digital divide that exists between India and Bharat, and the gap even between the Indians and Bharat. While she welcomed the allocation in the research and research-related activities, she looked forward to a better mechanism for outlining these partnerships and activities, for instance through the ICMR labs, or institutions both public and private. Despite the worry surrounding the digital divide, she talked about the probable positive impact of telemedicine in a country with an increasing mental health crisis. Prof Acharya too highlighted the growing problem of NCDs, with it almost doubling from the 1990s to 2016, according to her calls for a greater focus on NCDs and mechanisms for preventing it even schemes like WASH, Swachh Bharat Abhiyan and Har Ghar Jal Abhiyan are to be localized in this regard.
Our next panelist Mr. Abhijit Mukhopadhyay started with a look back at the pandemic and the healthcare crisis it created all over the world, with the struggle ranging from lack of adequate beds to ICU crisis to a very serious manpower crisis; crumbling healthcare infrastructure in many parts of the world. On the flip side, hopes were raised toward greater effort on building a better healthcare system, and a long-term vision to correct all these anomalies.
While discussing the gap in proper healthcare providers, Mr. Mukhopadhyay noted numbers by organizations like the WHO, the number of beds per thousand, in 2017 was 0.5, and around 8.6 doctors per 10,000 patients. While citing these numbers, he pointed out the lack of live practicing doctor registries in India. The shortfall of Primary Health Care Centres with only 44.2%, in Indian urban areas, is highlighted by data according to the Ministry of Health and Family Welfare. This shortfall is evident across states.
Mr. Mukhopadhyay highlighted an estimate by Dr. Chandrakant Lahariya, that the nominal increase if adjusted for GDP keeping the inflation, population, and growth all in the same period, allocation of the healthcare sector will be effectively reduced by 6.1%; which he agreed to.
After a question and answer session, the program concluded with closing remarks by Dr. Devendra Singh, who thanked and praised the team at the IMPRI Impact and Policy Research Institute for hosting a successful panel discussion and for ensuring the smooth functioning of the event. The event was concluded with a final vote of thanks by Ms. Nayana Agarwal on behalf of the IMPRI Center for Human Dignity and Development (CHDD).
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Acknowledgement: Samriddhi Sharma, a researcher at IMPRI

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